This is a 53-year-old woman with a history of migraines.
She had refractory sciatica and discal hernia L5-S1.
After informed consent and preoperative study without contraindications, L5-S1 microdiscectomy was performed.
The surgical technique, including preparation and positioning, was as follows:
- Anesthesia
General anesthesia was performed with orotracheal intubation.
Induction was performed with Propofol, analgesia with remifentanil (agonist of opioid m receptors, with analgesic potency similar to fentanyl), and relaxation with competitive neuromuscular blocking besylate or non-competitive neuromuscular blocking agent.
We used sevoflurane as a volatile anesthetic.
During the intervention, 100 mg of Tramadol (Analg of Central Action), pure nonselective agonist of opioid receptors, μ, delta and kappa ) and 25 mg of Dexketoprofen trometa were administered.
The duration of anesthesia was 1 hour 50 minutes, with no complications recorded.
- Collocation
The patient was operated in mahometane position, with the pectoral region and iliac crests supported by special pillow paths, with central sutures to avoid abdominal and breast decubitus.
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The head was supported by a hamstring-shaped padded system that was opened cranially.
To avoid eye support, the eyes were protected with a lush and eye pillows subjected to a bandage placed circularly on the head at the level of both eyes.
The lower limbs were padded in the decubitus position (myelitis).
The presence of dorsalis pedis and posterior tibial pulse was verified on both sides.
The patient's dorsum position was parallel to the ground.
- Surgical technique
Conventional microsurgery was performed with incision of fingers in the midline, section of common sacrolumen aponeurosis, retraction of extra muscles of the flavectomy, dissection of root hernia.
Blood loss was minimal and blood was not administered.
A small amount of 5 cc was used.
- immediate postoperative period
Upon awakening from anesthesia, the patient complained that she did not see anything absolutely from either eye.
Collaboration to Ophthalmology was requested, without finding pathology.
Ocular tension was normal.
The photomotor and consensual reflex were preserved.
Emergency brain CT was performed, in which an image in the right intraventricular choroidal circulation compatible with gas bubble was observed.
Another right occipital juxtaosseous image was considered doubtful.
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A cranial MRI showed a diffuse increase of signal in T2 sequences in posterior areas of both occipital lobes.
NMR angiography was normal.
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The clinical picture was interpreted as of vascular origin, either posicional, or derived from the patient's migraine history, being empirically treated with dexamethasone and vasodilators.
Six hours later, the patient complained of undistinguishable colorless and tennis, and a threat reflex appeared.
The next morning (12 hours after the intervention), she reported having recovered her vision, although she perceived crusted halos around the figures presented.
These dyschromatopsias disappeared within 24 hours.
A control MRI showed significant improvement of the occipital images seen in the previous MRI.
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Subsequent follow-up (one month after surgery) showed normal vision.
